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Pretendemos neste artigo explorar uma aparente chegada a Portugal de uma dinâmica de prossecução de políticas de integração cívica enquanto forma de promoção da integração de nacionais de países terceiros. Para tanto, partiremos de uma revisitação do conceito de integração e procuraremos destacar os momentos mais relevantes da evolução da política correspondente levada a cabo pela União Europeia. Finalmente, discutiremos as possibilidades deixadas em aberto pelo novo Plano de Ação para as Migrações, recentemente apresentado pelo governo português.

RESUMO Introdução: A Aprendizagem Baseada em Problemas ocorre por meio do trabalho em pequenos grupos, facilitado pelos tutores, devendo haver contribuição de todos para o alcance dos objetivos de aprendizagem. O estudante com perfil dominante pode desequilibrar essa dinâmica do grupo. Objetivo: Este estudo teve como objetivo compreender, na perspectiva da aprendizagem colaborativa, os significados atribuídos pelos docentes e discentes à presença do estudante com perfil dominante no grupo tutorial. Método: Realizaram-se dois estudos, de natureza qualitativa, com tutores e estudantes de uma faculdade do Nordeste do Brasil. O primeiro estudo objetivou compreender a percepção dos docentes sobre presença do estudante dominante no grupo tutorial. Para tanto, utilizaram-se entrevistas semiestruturadas para coleta das informações. A população foi composta por tutoras da graduação de Fisioterapia, com mais de dois anos facilitando grupos tutoriais. O segundo estudo objetivou compreender os significados atribuídos por discentes à presença do perfil de dominância nas tutorias. Utilizou-se o grupo focal como método de coleta. Participaram estudantes de Medicina dos quatro primeiros anos do curso. O processo de análise e interpretação das falas dos dois estudos foi ancorado nos pressupostos teóricos da aprendizagem colaborativa, os quais também serviram de referência para elaboração do roteiro das entrevistas e do grupo focal. Adotou-se a técnica da análise de conteúdo de Bardin. Os estudos foram aprovados pelo Comitê de Ética em Pesquisa com CAAE nº 26191119.5.0000.5569 e CAAE nº 38005320.5.0000.5569, respectivamente. Resultado: Os tutores e estudantes enfatizaram a diversidade encontrada no perfil de dominância. Caracterizaram o estudante com esse perfil como colaborativo, participativo e preparado. Apontaram também características de impaciência, dificuldade em escutar e aceitar colocações contrárias às suas, além de comportamento intrusivo, silenciando e limitando a participação de outros. As tutoras reforçaram a dificuldade em lidar com o estudante dominante, inclusive em dar feedback. Os discentes relataram que os tutores, perante o estudante dominante, não percebiam a ausência de colaboração no grupo e apresentavam insegurança para intervir. Conclusão: Os discentes expressaram tolhimento e insegurança diante da presença do estudante dominante, com prejuízo na construção do conhecimento do grupo e no desempenho individual, bem como decepção quanto à atuação do tutor. Os tutores demonstraram reconhecer as sutilezas dentro do perfil de dominância, apesar de suas dificuldades em intervir adequadamente.

Introduction and objectives: Increasing evidence shows that newborn weight loss is significantly influenced by the type of labour among other factors, implying a wider understanding of weight loss and its context to intervene accordingly. Given the importance of breastfeeding and the impact of infant formula use on its success, we aimed to understand the impact of the application of nomogram weight loss tools in initiating infant formula. Methods: This study included 206 newborns in a nonrandomised clinical trial, who were divided into two groups. In the intervention group, weight loss was managed through the use of the “Early Weight Loss Nomogram”, rather than with clinical experience associated with weight loss percentage, the standard type of care. We analysed the characteristics of mothers, newborns, and labours and their influence on each group. Results: We found that the introduction of formula milk due to weight loss tended to diminish (61.3% vs. 38.7%, p = 0.082) and nurses’ suggestions dropped to zero in the intervention group. The intervention group reported a longer period of exclusive breastfeeding, up to nearly six months of age. The babies who were not breastfed during the first hour of life were more often supplemented (78.6% vs. 21.4%, p < 0.001) and those with skin-on-skin contact were given a lower proportion of formula milk (69.8% vs. 30.2%, p < 0.001). Discussion: Application of the nomogram allowed the introduction of formula milk in more selected cases. This tool should be applied in healthcare units because it increases health professionals’ awareness of the criteria for formula supplementation.

Objectives: The aim of the present study was to investigate if there are differences in mitigation acute pain following oral surgery procedures within a hospital setting and regarding various medication regimens. Materials and methods: A systematic literature search was performed between the years 2013 and 2023, including the databases PUBMED, Cochrane and Scopus, to identify the clinical trials investigating the prescription of non-steroidal (NSAID’s) anti-inflammatory drugs before or after an oral surgery. A meta-analysis with meta-regression model was employed on the primary and secondary outcomes, such as pain, swelling and trismus. Results: Thirty-six articles were included, 6 of them being retrospective and 30 prospective, with a higher proportion of women than men, at a ratio of 1.34:1 and an average age of 31.9 years. Drugs with medium duration of action demonstrated lower values for pain and swelling. Regarding these parameters, pain and swelling, propionic acid derivatives and acetic acid derivatives exhibited lower values respectively. Conclusions: The quality of evidence was low to very low-certainty. The meta-analysis suggests that postoperative pain, swelling and trismus following oral surgery management may be effectively treated with the following drugs: NSAID medium-duration action drugs; propionic acid derivatives for lower pain levels and acetic acid derivatives for lower swelling measures; and Ibuprofen 400mg every 8h for 3 days or less. Clinical Relevance: Anti-inflammatory and analgesic drugs are prescribed to prevent or treat dental pain. Ibuprofen 400mg was the most prescribed drug after or before an oral surgery procedure. However, the evidence is indirect and needs to be interpreted with caution.

Within the healthcare sector, deploying Machine Learning (ML) models involves trial-and-error approaches, considerable time to create task-specific models, and collaboration between ML experts and physicians. To overcome these hurdles, Automated Machine Learning (AutoML) appears as a promising resource towards the advancement of precision and personalised medicine. Despite being a hot topic, AutoML remains relatively underexplored in the realm of medical imaging. To address this gap, the research objectives are to enrich the body of knowledge by comprehensively exploring the AutoML solutions, evaluating and comparing their performance, and even verifying their compliance to Explainable Artificial Intelligence (XAI) principles. Furthermore, we provide a unified solution with open-source AutoML solutions, as they seek to democratize access for less experienced users. Thus, this research paper contains a methodology to identify and evaluate 5 solutions, Fastai, Ktrain, Ludwig, Autogluon, and Autokeras, across 3 relevant medical imaging datasets. Their evaluation involved binary classifications using chest X-rays and breast histopathological images, and a multi-class scenario with brain Magnetic Resonance Imaging (MRI) images. Results reveal that both Ktrain and Fastai consistently demonstrate lower F1-Score values, regardless of the dataset. This stems from their limited level of automation, as the user is required to introduce the type of architecture and fine-tune certain hyperparameters. In contrast, Ludwig when employing the EfficientNet architecture, it roughly takes 10 minutes to achieve an F1-Score of $98.06{\pm }0.86$ % with the chest X-ray dataset. About 17 minutes to acquire $98.16{\pm }0.50$ % with the histopathological dataset, and nearly 7 minutes to reach an F1-Score of $96.52{\pm }1.07$ % with the brain MRI dataset. In this dataset is where Autokeras and Autogluon failed to provide suitable metrics for a typical multi-class problem. Nonetheless, in both binary scenarios, they achieve state-of-art results. Although having a higher execution time than Ludwig, they have a more robust search space. Finally, our findings highlight the need to incorporate XAI principles to improve the user’s experience, particularly for non-ML practitioners.

Introduction: Single-agent oral vinorelbine is a standard of care for hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-negative advanced breast cancer (ABC) that has progressed on endocrine therapy. Metronomic administration may offer a better balance of efficacy and safety than standard regimens, but data from previous trials are scarce. Methods: In this open-label, multicenter, phase II trial, patients were randomized to oral vinorelbine administered on a metronomic (50 mg three times weekly) or weekly (60 mg/m2 in cycle 1, increasing to 80 mg/m2 if well tolerated) schedule. Treatment was continued until disease progression or intolerance. The primary endpoint was disease control rate (DCR, the proportion of patients with a best overall confirmed response of CR, PR, or stable disease lasting 6 months or more). Results: One-hundred sixty-three patients were randomized and treated. The DCR was 63.4% (95% confidence interval [CI]: 52.0–73.8) with metronomic vinorelbine and 72.8% (95% CI: 61.8–82.1) with weekly vinorelbine. Weekly vinorelbine was also associated with longer progression-free survival (5.6 vs 4.0 months) and overall survival (26.7 vs 22.3 months) than metronomic vinorelbine, but was associated with more adverse events. Conclusions: In this randomized phase II trial, single-agent metronomic oral vinorelbine was effective and well tolerated as first-line chemotherapy for patients with HR-positive/HER2-negative ABC. Formal comparisons are not done in this phase II study and one can simply observe that confidence intervals of all endpoints overlap. When deciding for a chemotherapy after failure of endocrine therapy and CDK 4/6 inhibitors, oral vinorelbine might be an option to be given with either schedule. Clinical trial registration number: EudraCT 2014-003860-19.

Abstract Background Rearrangements in the anaplastic lymphoma kinase (ALK) gene define a molecular subgroup of non-small-cell lung carcinoma (NSCLC) that should be treated with ALK-targeting tyrosine kinase inhibitors (TKIs). Objective This study aimed to portray the Portuguese reality about the diagnosis and treatment of stage IV ALK-positive NSCLC. Methods Institutions that treat lung cancer in Portugal were invited to participate in an anonymous electronic questionnaire. A total of 22/35 geographically dispersed institutions responded. A descriptive statistical analysis of the results was performed. Results Reflex molecular testing was done in 54.6% of the institutions. Next-generation sequencing (NGS) was the preferred diagnostic method (90.9%). Typically, physicians obtained molecular study results within 14–21 days. Alectinib was the most commonly used first-line treatment. For patients with brain metastases, 86.4% of the physicians preferred alectinib and 13.6% preferred first-line brigatinib. In the case of asymptomatic oligoprogression in the central nervous system, 85.7% of physicians performed local treatment and kept the patient on a TKI; if symptomatic, 66.7% gave local treatment and stayed with the TKI, while 28.6% gave local treatment and altered the TKI. For patients with symptomatic systemic progression, 47.6% and 38.1% of physicians prescribed lorlatinib after initial treatment with alectinib or brigatinib, respectively. After progression on lorlatinib, 42.9% of respondents chose chemotherapy and 57.1% requested detection of resistance mutations. Conclusions NGS is widely used for the molecular characterization of ALK-positive NSCLC in Portugal. The country has access to up-to-date therapy. Overall, national clinical practice follows international recommendations for the diagnosis and treatment of ALK-positive NSCLC.

The olive tree is one of the most common type of cultivation in the Mediterranean area, having high economic and social importance. The Alentejo region, Portugal, is an area with a high presence of olive groves, which in 2022 accounted for 201,474 hectares. The aim of this study was to assess the relationship between olive pollen, weather data, and olive tree production, between the years 2002 and 2022. Pollen data were obtained from an urban station located in Évora, in the Alentejo region, and were used to calculate several metrics, such as the Pollen Season Duration (PSD), Seasonal Pollen Index (SPIn), peak value, and weekly pollen accumulation values. Monthly minimum, maximum, and mean temperature and precipitation sums were obtained from the E-OBS observational dataset. Considering the relationship between pollen/weather and olive production, mutual information and correlation analyses were conducted. Subsequently, several machine learning algorithms were trained using pollen and weather datasets, and we obtained suitable forecast models for olive tree production after cross-validation. The results showed high variability in pollen concentrations in Évora over the years. Complex associations were found, with certain weeks of pollen accumulation showing significant mutual information with olive production, particularly during June. The analyzed linear correlation coefficients remained generally low, underscoring the challenge of predicting olive production based on linear relationships. Among the machine learning algorithms employed to predict olive production, Decision Trees, Extreme Gradient Boosting, and Gradient Boosting Regressor were the most robust performers (r2 > 0.70), while linear models displayed a subpar performance (r2 < 0.5), emphasizing the complexity of this approach. These models highlight the roles of maximum and minimum temperatures during March and May and pollen accumulation during the second half of June. The developed models may be used as decision-support tools by growers and stakeholders to further enhance the sustainability of the thriving olive sector in southern Portugal.

The literature unequivocally acknowledges the numerous health benefits that physical activity (PA) provides. However, in other variables, such as cognitive performance (CP), the PA characteristics required to elicit favorable benefits remain controversial, particularly among adolescents. The aim was to investigate the evolution of CP in adolescents over the school year, as well as the role of regular PA levels. The study included 366 adolescents (boys n = 154), between 12 and 20 years old (15.46 ± 1.63), from middle school (n = 123) and high school (n = 243). CP was assessed through a face-to-face interview employing the Cognitive Telephone Screening Instrument. The variation in CP (∆CP) was determined by the difference between the value of the final assessment (end of the school year) and the initial assessment (start of the school year). PA was assessed using accelerometry (ActiGraph GT3X+). The CP score improved from the initial to the final assessment (37.80 ± 9.26 vs. 40.45 ± 10.05) (t = −6.135; p < 0.001; Glass’s Delta = 0.37. Multiple linear regression revealed that age (ß = −0.332; t = −4.255; p < 0.001) and high-intensity PA (ß = 0.283; t = 3.627; p < 0.001) accounted for 17.2% of the variation in ∆CP. CP improved significantly over the school year, emphasizing the significance of age and vigorous PA in ∆CP in adolescents.

The study addressed two main objectives: (i) to investigate disparities in motivation dimensions regarding extracurricular physical activity and (ii) to identify the influence of motivation on time spent in formal and informal physical activity. A sample of 704 adolescents (56% girls) from middle (46%) and high school (54%), with an average age of 14.88 ± 2.52, was assessed for different motivation dimensions using the Questionnaire of Motivation for Sports Activities (QMSA). Additionally, participants were categorized based on extracurricular physical activity practice. Multivariate analyses and multiple linear regressions were conducted to examine the effect of physical activity type on motivation dimensions and identify predictors of time spent in formal and informal physical activities, respectively. Results indicated that motivation varied significantly with extracurricular physical activity practice (p < 0.05), with students involved in extracurricular activities being more motivated. Sex and age differences were observed, with boys showing higher motivation in certain dimensions (achievement status (p < 0.001); group activity (p = 0.027); contextual (p = 0.004); technical improvement (p = 0.012) and older participants having lower scores in all dimensions. The influence of family and friends was a significant predictor only for boys in formal physical activity (p = 0.039). In terms of time spent in physical activity, group activity was a predictor for informal activities (p < 0.001), while technical improvement was a predictor for formal activities (p < 0.001), with notable sex differences. These findings underscore the importance of considering sex- and age-specific motivations when promoting physical activity among adolescents.

PurposeTo culturally adapt the Musculoskeletal Health Questionnaire (MSK-HQ) to European Portuguese and evaluate its reliability in individuals with musculoskeletal conditions.Materials and methodsThe study was carried out in two phases. In the first phase, the MSK-HQ was translated and culturally adapted. In the second phase, a longitudinal observational study was carried out with a convenience sample of participants with musculoskeletal conditions. Data collection began at the start of physiotherapy treatments by filling in the MSK-HQ and Numeric Pain Rating Scale (NPRS). After 4-7 days, the participants were asked to fill out the MSK-HQ once again, as well as the Patient Global Improvement Change (PGIC) scale. The data collected was used to study internal consistency, test-retest reliability, and measurement error. Floor and ceiling effects were also analysed.ResultsThe MSK-HQ was successfully translated and adapted into European Portuguese. The second phase of the study had a sample of 191 participants. This study demonstrated high internal consistency (Cronbach's α = 0.885) and excellent test-retest reliability (ICC(2,1) = 0.908). The analysis of measurement error resulted in an SEM of 2.818 and an SDC at 7.811. No floor or ceiling effect was observed.ConclusionsThe MSK-HQ-PT is a reliable instrument for measuring musculoskeletal health. Further studies on its validity and responsiveness are needed.

RESUMO Défices na Comunicação Social e Interação Social (CSIS) e nos Padrões Restritos e Repetitivos de Comportamentos, Interesses ou Atividades (PRRCIA) em crianças com Perturbação do Espetro do Autismo (PEA) são frequentemente explicados por problemas nas funções executivas (FE) e empatia. O objetivo deste estudo foi analisar associações entre FE e empatia em 75 crianças com PEA (9,67±1,29), previamente separadas em dois grupos de acordo com a frequência de comportamentos típicos da PEA. Usando o Inventário Comportamental de Avaliação das Funções Executivas - Pais e a Escala de Avaliação da Empatia foram encontradas diferentes associações entre FE e empatia em ambos os grupos. No grupo com baixa frequência de comportamentos, as FE têm maior associação com CSIS (Grupo 1) do que os PRRCIA. O grupo com maior frequência de comportamentos e frequência mais homogênea entre os dois domínios (Grupo 2) apresentou associações mais fortes entre FE e PRRCIA e entre FE e empatia cognitiva. Comportamentos típicos do PEA foram melhor explicados pelas FE do que por empatia. A identificação de dificuldades nos processos neurocognitivos implicados nos comportamentos típicos da PEA poderá levar à maior adequação da intervenção numa perspetiva mais abrangente e, consequentemente, melhorar o funcionamento e comportamento adaptativo da criança no seu dia a dia.

Abstract There is a growing piece of evidence that artificial intelligence may be helpful in the entire prostate cancer disease continuum. However, building machine learning algorithms robust to inter- and intra-radiologist segmentation variability is still a challenge. With this goal in mind, several model training approaches were compared: removing unstable features according to the intraclass correlation coefficient (ICC); training independently with features extracted from each radiologist’s mask; training with the feature average between both radiologists; extracting radiomic features from the intersection or union of masks; and creating a heterogeneous dataset by randomly selecting one of the radiologists’ masks for each patient. The classifier trained with this last resampled dataset presented with the lowest generalization error, suggesting that training with heterogeneous data leads to the development of the most robust classifiers. On the contrary, removing features with low ICC resulted in the highest generalization error. The selected radiomics dataset, with the randomly chosen radiologists, was concatenated with deep features extracted from neural networks trained to segment the whole prostate. This new hybrid dataset was then used to train a classifier. The results revealed that, even though the hybrid classifier was less overfitted than the one trained with deep features, it still was unable to outperform the radiomics model.

Acute heart failure is a frequent cause of hospital admission in Portugal, and has an increasing tendency given the aging population. Although most admissions for acute heart failure are caused by congestive conditions, not all patients have a congestive phenotype, reflecting the complexity of a process with multiple pathophysiological pathways. The use of diuretics, usually loop diuretics, is the mainstay of treatment for congestion. However, many patients develop resistance, thus constituting a challenge with no consensual solution to date, despite extensive debate over the years. Despite its frequent use in clinical practice, the co-administration of albumin and furosemide remains controversial in the management of patients with acute heart failure, hypoalbuminemia, and diuretic resistance. This review addresses the pathophysiological mechanisms of congestion in patients with acute heart failure and explores the theoretical basis that supports the co-administration of albumin and furosemide in this clinical context. It is intended to clarify the potential benefit of the combined approach in this specific population and identify possible gaps in the literature that could be the subject of future studies.

Congenital cutaneous candidiasis (CCC) is a rare condition in neonates, mainly in term neonates, that develops in the 1st week of life. Its broad clinical spectrum makes it challenging to differentiate it from other exanthemas in the newborn. The involvement of palms and soles and the presence of pustules are important clinical clues for the differential diagnosis, with cultural examination confirming the diagnosis by identification of Candida spp. Treatment of clinically stable term neonates without evidence of invasive disease is currently controversial. We report a case of CCC in a term newborn with no evidence of invasive disease that evolved into a clinical cure after systemic and topical antifungal treatment.

A síndrome pós-trombótica (SPT) é uma complicação tardia da trombose venosa profunda (TVP) que surge em 20%- 50% dos doentes. A sua sintomatologia é causa de grande morbilidade e compromete a qualidade de vida dos doen- tes. Assim, a prevenção da SPT após um episódio de TVP é fundamental. Várias guidelines têm recomendado o uso de meias elásticas compressivas diariamente como forma de prevenção da SPT. Contudo, o ensaio SOX veio alterar este paradigma ao concluir que não existiu benefício no uso de meias compressivas. Desde então, vários estudos têm sido feitos nesta área, uma vez que o seu uso apresenta também algumas desvantagens como o preço e o desconforto. O objetivo desta revisão consiste em determinar a eficácia da utilização de meias elásticas compressivas na prevenção da SPT. Dos 16 artigos obtidos a partir das diferentes bases de dados, 8 foram incluídos na revisão narrativa. Fo- ram também incluídas guidelines internacionais sobre este tema, nomeadamente as European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Vários estudos apontam para a não redução da incidência de SPT com a utilização de terapêutica compressiva, enquanto outros continuam a sugerir benefícios com o seu uso. Os estudos analisados apresentam evidência muito contraditória, sendo controver- sa a recomendação do uso de meias compressivas na profilaxia do SPT. Uma limitação da presente revisão deve-se à heterogeneidade dos estudos. Assim, são necessários estudos de melhor qualidade, com amostras populacionais maiores e metodologias mais homogéneas, para que se possa concluir de forma inequívoca se existe ou não benefício na utilização das meias compressivas.

RESUMO Objetivo Elaborar e validar um curso sobre Ciências Básicas em Oftalmologia. Métodos Foi realizado um estudo metodológico para elaboração e validação de material didático, na modalidade à distância, por meio do desenho instrucional ADDIE. O desenho é composto de três de cinco etapas: análise, desenho e desenvolvimento. Foi utilizada a taxonomia revisada de Bloom para definição dos objetivos de aprendizagem. O curso foi submetido à validação do conteúdo, via remota, por meio de grupo de consenso selecionado pelo modelo de Fehring, segundo as normas da resolução 510/2016. Resultados O curso elaborado e validado tem duração prevista de 15 horas e possui 19 objetivos de aprendizagem distribuído em seis unidades pedagógicas. Contempla o conteúdo programático utilizando diversos recursos tecnológicos interativos e apresenta-se com avaliações formativas de sedimentação do conteúdo ao fim de cada unidade. Conclusão O curso de Ciências Básicas em Oftalmologia na modalidade à distância validado promete democratizar o ensino da Oftalmologia às instituições de ensino credenciadas pelo Conselho Brasileiro de Oftalmologia.

IntroductionThe rising incidence of skin cancer over the years has made it a significant public and occupational health issue. However, skin cancer is highly preventable, mainly through reduced exposure to solar ultraviolet radiation (UVR), which can be achieved by a variety of individual and collective protective measures and interventions. The relative risk associated with different patterns of exposure to solar UVR differs for the subtypes of keratinocyte cancers (KC). Specifically, whether the exposure is intermittent or continuous, and occurs in an occupational or leisure/recreational setting. The main aim of the study using this protocol is to contribute to raising public and policy awareness on solar UVR-inflicted occupational skin cancers in Lisbon. This will be achieved by performing direct measurements of the solar UVR dose received by outdoor workers using a digital platform. Results will likely contribute to further understanding the risk estimates for keratinocyte cancer estimations in this population.MethodsA prospective observational study will be conducted in Lisbon, Portugal. Personal electronic dosimeters (GENESIS-UV system) integrated with a digital platform will be used to assess occupational solar UVR doses of gardeners, masons, and gravediggers of the municipality of Lisbon. Two hundred and ten outdoor workers will be selected to wear the dosimeter for 1 month each, between April and October during their daily working hours. A digital web-based platform that offers private access to information through dashboard visualization will provide information for the outdoor workers and facilitate communication with the participants.DiscussionThe expected results of the overall proposal comprise the occupational solar UVR doses, expressed in standard erythemal dose (SEDs) per day of outdoor work for 7 months. Study data will provide outdoor workers with information on their personal solar UVR exposure during their working hours and an estimate of their risk of developing skin cancer. It is expected that the occupational solar UVR doses of the outdoor workers in Portugal will be above the threshold of 1 to 1.33 SED/day, due to the latitude of Lisbon and the nature of the occupations. The results prospectively should flow into the design of adequate prevention campaigns for skin cancer in outdoor workers.

Abstract Background Social media platforms are increasingly being used by stakeholders to generate, access, and share health-related information and experiences. Lung cancer is the most common cancer, impacting > 2 million patients globally. This observational study utilized a social listening approach to analyze social media trends and gain insights into stakeholder perceptions of lung cancer. Methods This social media study retrospectively collated data from open access blogs, forums, and social networking sites. Social media posts were collected between June 2019–May 2020 from 14 European countries. Using social media aggregator tools, posts comprising lung cancer and non-small cell lung cancer-specific terms were extracted. Manual and automated relevancy algorithms filtered the extracted information to provide the relevant dataset. This contextualized dataset was further mined to generate the final data for analysis. Results Of 1360 conversations analyzed, 42% were generated by patients/caregivers and 14% by healthcare professionals (HCPs). A majority of patients were 51–70 years old (approximately 50%) and 91% (n = 500/550) had late-stage cancer. Treatment (35%) and disease awareness (30%) were among the most discussed topic of the patient journey. Although the overall treatment sentiment was neutral, chemotherapy was the treatment type with the highest associated negative sentiment (28%); fewer negative sentiments were associated with immunotherapy (9%) and targeted therapy (2%), due to perceptions of longer survival outcomes and fewer side effects. In conversations that discussed clinical endpoints, “survivability” and “overall survival” (47 and 30%, respectively; n = 539) were most frequently mentioned by stakeholders. HCPs mostly used technical terms, whereas patients and caregivers used colloquial terms such as “getting rid of cancer”. Emotional wellness was identified to have a huge impact on quality of life in lung cancer. Delay or treatment cancellations due to COVID-19, lack of effective treatments and funding, and lack of empathy by physicians emerged as the key unmet needs among patients/caregivers. Conclusions Social listening proved to be an effective tool to explore stakeholders’ perceptions and their key unmet needs, typically not available in published literature or databases, and provides HCPs with valuable insights into the distress, doubts, and needs of lung cancer patients and caregivers.

Non-small-cell lung cancer (NSCLC) is a major cause of cancer-related death worldwide. In recent years, the discovery of actionable molecular alterations has changed the treatment paradigm of the disease. Tissue biopsies have been the gold standard for the identification of targetable alterations but present several limitations, calling for alternatives to detect driver and acquired resistance alterations. Liquid biopsies reveal great potential in this setting and also in the evaluation and monitoring of treatment response. However, several challenges currently hamper its widespread adoption in clinical practice. This perspective article evaluates the potential and challenges associated with liquid biopsy testing, considering a Portuguese expert panel dedicated to thoracic oncology point of view, and providing practical insights for its implementation based on the experience and applicability in the Portuguese context.

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Abstract The article discusses to what extent sociological theories produced in the Brazilian academic field dialogue with a global intellectual movement criticizing coloniality and the Eurocentric foundations of the social sciences. Initially, we analyze the challenges regarding the attempts to define two theoretical approaches, Brazilian sociology, and Postcolonial Thought, without overlooking their internal heterogeneities. Then, we address the tensions between these approaches as conditions for research agendas that bring both contributions into proximity. Finally, we explore the epistemological potential of one of these agendas, which corresponds to a rereading of Brazilian sociological theory in light of postcolonial criticism. This exercise in rereading the canon is based on the methodological program of sociological reduction of Guerreiro Ramos, which indicates a reciprocal interrogation between Brazilian sociology and postcolonial thought, i.e., a decentered look at our sociological tradition that also reveals contributions from this tradition for the future of postcolonial epistemologies.

Antimicrobial resistance is a serious problem for the control of infections and infectious diseases. Propolis is a substance produced by honeybees with antimicrobial and antibiofilm properties. To consider propolis as an alternative to the use of antimicrobials for infection control, we assessed its antimicrobial and antibiofilm activities. To assess propolis for topical medical use, toxicological studies were also performed. A Portuguese 70% propolis ethanolic extract was chemically evaluated and studied for antimicrobial activity on staphylococcal field isolates (n = 137) and antibiofilm action (n = 45). Cell toxicological assessment was performed using keratinocytes and fibroblasts. Pinobanksin, chrysin, acacetin, apigenin, pinocembrin, and kaempferol-dimethyl-ether were detected. All 137 isolates were susceptible to 6.68 mg/mL or lower propolis concentration (80% isolates were susceptible to Staphylococcus spp. that deserves to be evaluated in vivo.

Sports participation is one of the most popular forms of physical activity among youngsters. This study aimed to examine the changes in the estimated body composition, strength, and flexibility of adolescent boys after 12 months of soccer training compared with those of age-matched controls with non-sports participation. We assessed 137 boys (62 soccer players and 75 controls) at baseline (TM1) and 12 months later (TM2). The differences in estimated body composition, strength, and flexibility were investigated using a repeated measure analysis of variance. The analysis revealed a significant main effect of soccer training on fat mass (F = 73.503, p ≤ 0.01, η2 = 0.59) and fat-free mass (F = 39.123, p ≤ 0.01, η2 = 0.48). Over time, the soccer group decreased their fat mass and increased their fat-free mass, while the opposite results were observed for the controls. Among physical fitness tests, a substantial effect of soccer training was evidenced for the sit-up performance (F = 16.224, p ≤ 0.01, η2 = 0.32). Regarding the time factor, significant effects were noted for height and handgrip strength. No significant differences were detected for flexibility. Overall, the benefits of soccer training were exhibited by the larger improvements in fat mass, fat-free mass, sit-ups, and handgrip strength performance, underlining the important role of soccer participation during adolescence.

Objective: Better understanding of dental age assessment may help in cases of age estimation in Forensic Clinics. The first aim was to provide essential information on method reliability for upcoming studies using dental age assessment by second molar index (I 2M ), and third molar index (I 3M ) for age estimation on legal ages of 12 - 14 years. The second aim was to document forensic method outcomes of the Demirjian method which has already been used in forensic clinic. Material and methods: Two samples were used for this purpose: for I 2M , 633 orthopantomographs (270 females / 363 males), the age range from 7 to 17 years and for I 3M , 471 orthopantomographs (253 females / 218 males), the age range from 10 to 23 years, from the database population of Lisbon North University Hospital Center, approved by the Ethic Committee. Results: The I 3M cut-off point (1.133) for 12- year-olds obtained better results than the cut-off point stated by the I 2M (0.135). Besides, I 2M cut-off point (0.001) for 14- year- olds showed better results when compared with the cut-off point (0.705) established by the I 3M . Both methods are reliable for the legal age thresholds of 12 and 14 years. However, using I 2M and I 3M allows us to vary the cut-off value to privilege sensitivities or specificity, depending on which is more appropriate to the intended application. Conclusions: The accuracy (88.94%) of I 3M obtained better results for the 12- year- old cut-off point (1.133) and the accuracy (90.21%) of the I 2M performed better for the 14- year- old cut-off point (0.001).

Background and aims – Molecular phylogenetic studies have provided a clearer understanding of the complex relationships within the family Cyperaceae. These studies have consistently shown that 12 allied genera are nested in the genus Cyperus. However, early Sanger sequencing-based phylogenies that included the two species of the small South American genus Androtrichum were inconclusive in placing this genus either as sister to Cyperus or as part of its early divergent lineages. A recent phylogenetic analysis however conclusively placed the two species of Androtrichum within the C3 Cyperus Grade. In this study, we investigate if the morphology and anatomy of Androtrichum species provide additional evidence for their placement in the genus Cyperus. In addition, we provide descriptions and distribution data for the species.Material and methods – Herbarium material from FLOR, FURB, GENT, ICN, and K has been studied. Samples of the culm and leaf were studied using histological methods. Taxonomic changes and typifications of names were performed according to the International Code of Nomenclature for algae, fungi, and plants. Key results – The morphology and the non-Kranz anatomy observed in the Androtrichum species confirm their placement among the other C3 Cyperus species. Androtrichum is combined into Cyperus. For one species, a combination in Cyperus is already available: Cyperus trigynus. For the other species, a new name in Cyperus is published: Cyperus byssaceus. Two typifications are established and morphological descriptions and distribution data are provided. Conclusion – By integrating recent molecular phylogenetic data with additional evidence from morphology and anatomy, Androtrichum is combined into Cyperus. As a result of this taxonomic change, a single monophyletic genus Cyperus is now recognised in the Cyperus Clade of tribe Cypereae.

A Psicanálise defende a importância do olhar como um canal propiciador às trocas relacionais pais-filho, uma construção afetiva que tem impactos à constituição subjetiva do bebê. O acolhimento ao filho também se dá pelo olhar materno e paterno, que banha seu corpo de afetos, permitindo que as necessidades infantis sejam atendidas ou não, conforme a interpretação dos agentes da especularização sobre os sinais do bebê. Do ponto de vista da mãe, o olhar do bebê evoca experiências afetivas em si mesma, como angústia, prazer e gratificação. Embora a função do olhar possa ser construída mesmo sem o suporte da visão, argumentamos que um desalinhamento visual pode impactar as trocas relacionais, alertando sobre a importância do olhar, enquanto construção, para a constituição subjetiva do bebê. Este artigo desenvolve reflexões sobre a construção do olhar em díades mãe-bebê no contexto do estrabismo infantil. Foram entrevistadas cinco mães de bebês estrábicos, com idade entre seis e doze meses. As mães se deram conta da alteração visual, sobretudo, na amamentação. Apesar do impacto psíquico, com sentimentos de culpa, frustração e ansiedade, a maioria não se paralisou diante da angústia e buscou apoio. Aparentemente tiveram pouco ou nenhum espaço de escuta junto aos profissionais de saúde, embora tenham sentido alívio da ansiedade a partir de consultas com esclarecimentos e possibilidades de tratamento. Ainda que esta pesquisa não indique elementos de cunho etiológico, o estrabismo pode envolver uma dimensão psíquica nas trocas iniciais que não deve ser negligenciada. Estimula-se que profissionais envolvidos com a primeira infância escutem as ambivalências maternas e paternas nas trocas com o bebê, buscando observar a qualidade da interação pelo olhar, que indica o clima afetivo do par/tríade, base para a integração infantil.

Abstract: Introduction: Human Rights are inherent to the human condition, considering all aspects of life: the right to life, to an education, to freedom, to religion, to security and to work. Given that, it is important to nurture a Human Rights culture in educational institutions, aiming at improving inter-personal dynamics and the educational environment. The tutors’ development, in this aspect, becomes fundamental. Objective: To understand the meanings attributed by tutors to their experiences involving Human Rights situations in the academic environment as the first step to implement teacher development in this area. Methods: qualitative study involving tutors from a college located in northeastern Brazil, which employs the Problem-Based Learning methodology, between December of 2019 and September of 2020. The collection was performed through focal groups with intentional selection. The script for the discussion was based in the National Plan for Human Rights Education, The Human Rights Education Manual, The Universal Human Rights Declaration and articles related to the discussion topic. Bardin content analysis was used. The project was approved by the Ethics Committee under CAAE number 22696919.3.0000.5569. Results: The studied analytic categories were: gender and sexuality, communication and freedom of speech, social minorities and student self-esteem and stigmatization. During the process of reinterpreting the collected content, the following empirical subcategories were identified: ableism, fatphobia, psychophobia and interpersonal conflicts. The tutors revealed having experienced conflicts involving Human Rights, as follows: gender oppression; homophobia by students and teachers; lack of racial representativeness among the college student population; fatphobia in the academic environment; decrease in student’s performance due to mental health issues. The participant tutors also expressed insecurity when it came to intervening and giving feedback in such situations, as well as some lack of knowledge about Human Rights. Conclusion: The tutors reported episodes that demonstrated Human Rights violation practices in the academic environment and showed to be insecure about intervening in such situations, especially when these situations led to conflict between the students.

O presente trabalho tem como objetivo realizar uma revisão narrativa de literatura a respeito da ativação de crenças do terapeuta durante o processo psicoterápico, por meio da perspectiva cognitivo-comportamental. Busca-se compreender os impactos desse fenômeno na atuação do profissional, suas possíveis interferências e contribuições para o trabalho interventivo, bem como a utilização e formulação de estratégias para manejo desse processo. Para tanto, foram abordados os conceitos de relação terapêutica na terapia cognitivo-comportamental, transferência, contratransferência e distorções cognitivas, visando refletir sobre o impacto que causam no terapeuta e em sua prática clínica. Retoma-se a questão da formação e supervisão como alternativas para minimizar a interferência das distorções cognitivas do psicólogo no exercício de seu trabalho e como recursos para o aprimoramento de sua capacidade de escuta e intervenção. Por fim, questionam-se os limites da literatura na área e os observados no estudo proposto.

ABSTRACT A cross-sectional study based on the Self Determination Theory to identify intrinsic motivation in the tutorial group scenario, and its associated factors in 276 medical students from a college in the Northeast of Brazil between October and December 2016. The Intrinsic Motivation Inventory was utilized following its adaptation and cross-cultural translation. Variables studied: age, gender, marital status, financial dependents, number of attempts at the university entrance exam for the medical course, current semester of study, previous undergraduate training, living with parents, choice of course by parental influence or pressure. Uni and multivariate Poisson analysis were carried out to assess the factors associated with intrinsic motivation; p

Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extra-nodal non-Hodgkin lymphoma (NHL). It must be confined to the brain, eyes, spinal cord or leptomeninges without systemic involvement at the time of diagnosis. Disease confined to the cerebrospinal fluid (CSF) is a rare form of presentation and poses a particular diagnostic challenge. We present the case of an 82-year-old man admitted to hospital because of an acute confusional state, later revealed to be due to PCNSL with exclusive leptomeningeal involvement. The diagnostic process was further impaired (or, perhaps, aided?) by the onset of a COVID-19 outbreak on the ward.

Introdução: Fungos emergentes raros, como Saprochaete clavata, estão associados a doenças invasivas, alta mortalidade e surtos. Pouco se sabe sobre o perfil de S. clavata, epidemiologia, fatores de risco, tratamento, biofilmes e desfechos clínicos. Além disso, poucos dados sobre as características deste microrganismo foram relatados. O objetivo desse estudo foi descrever um novo caso de infecção grave causada por S. clavata diagnosticada em um hospital infantil de referência no Brasil, incluindo perfil de suscetibilidade a antifúngicos, caracterização do biofilme com atividade antifúngica no biofilme de S. clavata e caracterização morfológica. Métodos: Um isolado de S. clavata, isolada de um paciente imunocomprometido de 11 anos de idade, foi caracterizado e identificado por espectrômetro de massas (MALDI-TOF), coloração de Gram e Microscopia Eletrônico de Varredura (MEV). A produção de biofilme também foi avaliada, em paralelo. com determinação de concentração inibitória mínima (CIM), teste de sensibilidade antifúngica em biofilme usando a determinação da concentração mínima de erradicação de biofilme (MBEC), quantificação de células viáveis em biofilme, e quantificação de biomassa total em biofilme. O teste U de Mann-Whitney foi usado para comparar medianas; significância estatística foi observada quando houve diferença de menos de 5% (p < 0,05). Resultados: Colônias pequenas e médias, esbranquiçadas, farinosas, secas, com margem filamentosa, células semelhantes a leveduras com características bacilares, e foi observada a formação de biofilme, com valor de pontuação ≥ 2.000 pelo sistema MALDI-TOF. Os valores de CIM (em mg/L) foram: fluconazol: 2, voriconazol: ≤ 2, caspofungina: ≥ 8, micafungina: 2, anfotericina B: 4, flucitosina: ≤ 1 e anidulafungina: 1, enquanto a atividade antifúngica no biofilme de S. clavata foi mais expressiva ao avaliar anfotericina B. O MBEC, quantificação de células viáveis e biomassa total em biofilme mostraram redução expressiva do biofilme com anfotericina B. Conclusões: Foi observado que a anfotericina B apresentou ação eficiente contra o biofilme de S. clavata, com um CIM valor de 4 mg/L, enquanto fluconazol e anidulafungina, apesar de apresentar valores de CIM de 2 mg/L (para ambas as drogas), não apresentou efeitos significativos contra o biofilme de S. clavata. Essas descobertas são extremamente úteis para elucidar e compreender o uso de fluconazol, anidulafungina e da anfotericina B contra o biofilme de S. clavata.

Previous studies have reported that people with fibromyalgia (FM) could suffer from mitochondrial dysfunction. However, the consumption of muscle oxygen during physical exercise has been poorly studied. Therefore, this study aimed to explore the response of muscle oxygen during a fatigue protocol in people with FM and healthy controls (HC). In addition, the peak torque and the total work were assessed. A total of 31 participants (eighteen were people with fibromyalgia and thirteen were healthy controls) were enrolled in this cross-sectional study. All the participants underwent a fatigue protocol consisting of 20 repetitions at 180°·s−1 of quadriceps flexions and extensions using a Biodex System 3. The muscle oxygen saturation (SmO2), total hemoglobin (THb), deoxygenated hemoglobin (HHb) and oxygenated hemoglobin (O2Hb) values were measured using a portable near-infrared spectroscopy (NIRS) device. Significant differences between people with FM and healthy controls were found at baseline: SmO2 (FM: 56.03 ± 21.36; HC: 77.41 ± 10.82; p = 0.036), O2Hb (FM: 6.69 ± 2.59; HC: 9.37 ± 1.31; p = 0.030) and HHb (FM: 5.20 ± 2.51; HC: 2.73 ± 1.32; p = 0.039); during the fatigue protocol: SmO2 (FM: 48.54 ± 19.96; HC: 58.87 ± 19.72; p = 0.038), O2Hb (FM: 5.70 ± 2.34; HC: 7.06 ± 2.09; p = 0.027) and HHb (FM: 5.69 ± 2.65; HC: 4.81 ± 2.39; p = 0.048); and in the recovery at three min and six min for SmO2, O2Hb and HHb (p < 0.005). Furthermore, healthy control values of SmO2, O2Hb and HHb have been significantly altered by the fatigue protocol (p < 0.005). In contrast, people with FM did not show any significant alteration in these values. Moreover, significant differences were found in the peak torque at extension (FM: 62.48 ± 24.45; HC: 88.31 ± 23.51; p = 0.033) and flexion (FM: 24.16 ± 11.58; HC: 42.05 ± 9.85; p = 0.010), and the total work performed at leg extension (FM: 1039.78 ± 434.51; HC: 1535.61 ± 474.22; p = 0.007) and flexion (FM: 423.79 ± 239.89; HC: 797.16 ± 194.37; p = 0.005).

RESUMO: A Perturbação do Espectro do Autismo (PEA) caracteriza-se por défices na comunicação e na interação social e por padrões repetitivos e restritos do comportamento, eventualmente explicados por alterações nas funções executivas (FE) e empatia. O objetivo desta investigação foi, assim, estudar as relações entre os comportamentos típicos da PEA, FE e empatia, de forma a estabelecer orientações de intervenção. O Questionário dos Comportamentos Típicos da PEA, o Inventário Comportamental de Avaliação das Funções Executivas – Pais e a Escala de Avaliação da Empatia foram aplicados a 75 crianças com PEA (9.67±1.29). Os resultados apontaram correlações positivas entre a sintomatologia da PEA e as FE, nomeadamente na regulação comportamental e na metacognição. A correlação positiva mais forte (p

Background: Research on composition and physical fitness is lacking in school-aged children from Madeira. This study aimed to examine the frequencies of overweight and obese participants and, in addition, to compare the fitness levels of Madeira youth with reference data. Methods: The sample comprised 521 participants (n = 258 boys; n = 263 girls) aged 10.0–18.9 years old. Methods: Height and weight were measured. Body mass index (BMI) was calculated, and percent fat was derived from skinfolds. Tests detailed on FITESCOLA battery were performed. BMI was plotted against U.S. reference data and physical assessment contrasted with the cut-off points of FITESCOLA protocol and corresponding data developed in Portuguese youth. Results: The percentages of overweight and obesity were 15% (overweight) and 14% (obesity) for boys and 16% (overweight) and 6% (obesity) for girls. The median values of fat mass percentage were closely related to the cut-off standards; however, substantial variation was noted. Boys and girls tended to be below the recommendations of cardiorespiratory fitness. Conclusions: Sport participation should be promoted in Madeira to attain acceptable values of body composition and physical fitness levels.

The development of computational artifacts to study cross-modal associations has been a growing research topic, as they allow new degrees of abstraction. In this context, we propose a novel approach to the computational exploration of relationships between music and abstract images, grounded by findings from cognitive sciences (emotion and perception). Due to the problem’s high-level nature, we rely on evolutionary programming techniques to evolve this audio–visual dialogue. To articulate the complexity of the problem, we develop a framework with four modules: (i) vocabulary set, (ii) music generator, (iii) image generator, and (iv) evolutionary engine. We test our approach by evolving a given music set to a corresponding set of images, steered by the expression of four emotions (angry, calm, happy, sad). Then, we perform preliminary user tests to evaluate if the user’s perception is consistent with the system’s expression. Results suggest an agreement between the user’s emotional perception of the music–image pairs and the system outcomes, favoring the integration of cognitive science knowledge. We also discuss the benefit of employing evolutionary strategies, such as genetic programming on multi-modal problems of a creative nature. Overall, this research contributes to a better understanding of the foundations of auditory–visual associations mediated by emotions and perception.

Psychomotor intervention has been used to promote development by the enhancement of psychomotor and socio-emotional competence. However, studies with high-quality evidence, describing psychomotor-intervention processes and outcomes are scarce. Therefore, we aimed to generate expert consensus regarding psychomotor-intervention guidelines to support psychomotor therapists through the design and implementation of interventions for preschool (3–6 years old) children with autism spectrum disorder (ASD). A formal consensus process was carried out, using modified nominal group (phase I) and Delphi survey (phase II) techniques. We recruited 39 Portuguese experts in psychomotor intervention with preschool children with ASD in phase I. Experts participated in at least one of the five online meetings, discussing themes (e.g., objectives, methods, strategies) concerning psychomotor intervention with preschool children with ASD. A deductive thematic analysis from phase I resulted in 111 statements composing round 1 of the Delphi survey. Thirty-five experts completed round 1, and 23 round 2. The experts reached a consensus (agreement > 75%) on 88 statements, grouped under 16 sections, (e.g., intervention source, general setting, intended facilitation-style), reflecting generic psychomotor-intervention guidelines. Consensus guidelines may be used to support transparent and standard psychomotor interventions, although further studies should be undertaken to determine their efficacy.

RESUMO A identificação do perfil comportamental nas perturbações do neurodesenvolvimento deve ser apoiada por instrumentos válidos que auxiliem a escolha e a monitorização da intervenção e da alocação de recursos. Com a mudança de critérios de diagnóstico da Perturbação do Espetro do Autismo (PEA), surgiu a necessidade de construir um questionário que permitisse inventariar os comportamentos descritos. Assim sendo, este estudo teve como objetivo desenvolver e avaliar as propriedades psicométricas do Questionário dos Comportamentos Típicos da PEA (QCT-PEA). A validade de conteúdo do QCT-PEA, analisada por dez especialistas, foi comprovada pelos Índices de Validade de Conteúdo (IVC), com valores superiores a .95 e pela proporção de acordo, Cohen kappa (.82>k< 1). O QCT-PEA foi aplicado a 75 crianças com PEA (9.67±1.29). Na análise da fiabilidade, os comportamentos típicos totais da PEA e os dois domínios apresentaram valores que atestam a consistência interna (α>.88). Para a validade de constructo, os coeficientes de correlação de Pearson apontaram para correlações fracas a fortes (.26>rho

Resumo: Introdução: Na aprendizagem baseada em problemas, o tutor atua como facilitador, e, nesse contexto, as congruências social e cognitiva e o conhecimento do conteúdo são considerados aspectos fundamentais para o exercício dessa função. Objetivo: Este estudo teve como objetivo verificar o perfil de domínios de competências do tutor e a correlação com o desempenho do estudante. Método: Trata-se de um estudo transversal realizado de 2016 a 2017 com tutores e estudantes de Medicina da Faculdade Pernambucana de Saúde. Utilizou-se o coeficiente de Spearman para verificar a correlação do perfil de domínios de competência do tutor com o rendimento geral. Resultado: Participaram do estudo 34 tutores e 533 estudantes. Identificaram-se três domínios de competência nas frequências: congruência cognitiva em 88,7%, congruência social em 93,6% e conhecimento de conteúdo em 98,9%. Não foi observada correlação entre os domínios de competência e rendimento. Conclusão: Especula-se que esse achado se deva à falta de controle das variáveis de confundimento.

Previous studies showed that people with Fibromyalgia (FM) suffer from dysautonomia. Dysautonomia consists of persistent autonomic nervous system hyperactivity at rest and hyporeactivity during stressful situations. There is evidence that parameters reflecting the complex interplay between the autonomic nervous system and the cardiovascular system during exercise can provide significant prognostic information. Therefore, this study aimed to investigate the differences between people with FM and healthy controls on heart rate variability (HRV) and salivary parameters (such as flow, protein concentration, enzymatic activities of amylase, catalase and glutathione peroxidase) in two moments: (1) at baseline, and (2) after an exercise fatigue protocol. A total of 37 participants, twenty-one were people with fibromyalgia and sixteen were healthy controls, participated in this cross-sectional study. HRV and salivary samples were collected before and after an exercise fatigue protocol. The fatigue protocol consisted of 20 repetitions of knee extensions and flexions of the dominant leg at 180 °·s−1 (degrees per second). Significant differences were found in the HRV (stress index, LF and HF variables) and salivary biomarkers (with a higher concentration of salivary amylase in people with FM compared to healthy controls). Exercise acute effects on HRV showed that people with FM did not significantly react to exercise. However, significant differences between baseline and post-exercise on HRV significantly induce alteration on the HRV of healthy controls. Catalase significantly increased after exercise in healthy controls whereas salivary flow significantly increased in women with FM after an exercise fatigue protocol. Our study suggests that a higher α-amylase activity and an impaired HRV can be used as possible biomarkers of fibromyalgia, associated with a reduction in salivary flow without changes in HRV and catalase activity after a fatigue exercise protocol. More studies should be carried out in the future to evaluate this hypothesis, in order to find diagnostic biomarkers in fibromyalgia.

This paper presents a load-shift system with advanced functionalities for the power grid. When compared with the conventional approach, an advanced load-shift system allows the compensation of power quality problems on the power grid side, namely problems related to current harmonics, current imbalances, and low power factor. The advanced load-shift system is composed by a bidirectional ac-dc converter to interface the power grid and by a bidirectional dc-dc converter to interface an energy storage system. Since the main innovation is related with the power grid interface, the focus of this work is on the analysis of the ac-dc converter, which is based on a three-phase four-leg voltage source converter. A theoretical study and the details concerning the control algorithm are presented and discussed along the paper. A laboratory prototype of the advanced load-shift system was developed, and the main details of implementation are described in the paper. Experimental results obtained with the developed prototype prove that the advanced load-shift system contributes for the technology progress in this area, validating a new operation concept concerning the power quality on the power grid side. For all the operation modes, the system operates with high power factor and the currents on the power grid side are balanced with a low total harmonic distortion and in phase with the respective power grid voltages.

Introduction: Salivary gland tumors include a wide spectrum of histological subtypes and clinical behavior, which we aim to evaluate. Material and Methods: We performed a retrospective study of all salivary gland tumors diagnosed and treated at the Centro Hospitalar São João, Porto, between 2005 and 2015. Histological re- evaluation was performed in all cases and patient files were reviewed and both clinical and follow-up data were collected. Disease-free survival and overall survival were evaluated using Kaplan-Meier survival curves and compared using the Mantel-Cox log-rank test. The significance threshold was set at 0.05. Results: We selected 295 cases, 150 males with a mean age at diagnosis of 50.4 (± 16.4) years. Primary benign epithelial tumors [n = 228 (77.3%)] were mostly pleomorphic adenomas [n = 148 (64.9%)] and Warthin tumors [n = 61 (26.8%)]. Primary malignant epithelial tumors [n = 43 (14.8%)] included mucoepidermoid [n = 16 (37.2%)], adenoid cystic [n = 6 (14.0%)] and acinic cell [n = 5 (11.6%)] carcinomas; 32 (74.4%) in parotid, 2 (4.6%) in submandibular and 9 (21%) in minor salivary glands. Primary epithelial tumors were more frequently malignant in minor (33.3%) than in major (13.9%) salivary glands. Local recurrence occurred in 30.2% and distant metastases in 25.6% tumors. The mean disease-free interval was 26 (± 37.5) months; most metastases were in lung and central nervous system. The 5 and 10 year disease-free survival rates were 63.4% and 50.1%, respectively; the 5 and 10 year disease-specific survival rates were 76.9% and 57.9%, respectively. Primary salivary tumors included also lymphomas [n = 8 (2.7%)] and soft tissue tumors [n = 5 (1.7%)]. Secondary tumors included metastases of carcinomas [n = 7 (2.4%)] and involvement by lymphoma [n = 1 (0.3%)]. Discussion: Our results concerning age, gender, histological subtype, frequency and clinical behavior of salivary tumors concur with European studies. Divergence with Portuguese studies might be related with the inclusion criteria, clinical referral and time lag variations. Conclusion: Although uncommon, salivary gland tumors occur in a wide age range and include histological subtypes with diverse prognosis.

This paper seeks to identify the pedagogical resources used by kindergarten, primary and secondary teachers in Azores Islands. Additionally, an investigation will be made into how these resources are mobilized in teachers’ pedagogical practice, with the aim of understanding to what extent digital resources, particularly learning objects, are present in schools. For this purpose, a study was developed, which included a questionnaire survey conducted online, and sent to teachers in 2021/22. A total of 426 answers allowed us to conclude that the use of pedagogical resources is still far from the current and emerging need to mobilize digital resources, particularly learning objects, as a tool to enhance meaningful learning.

Objectives: (i) describe the profile of the volunteers at an adapted sporting event; (ii) know the motivations and expectations of the volunteers who participated in an international adapted swimming sporting event, and (iii) study the influence of the variation of motivation and expectations, before and after volunteering, and their intention to repeat the volunteering experience. Methodology: 74 volunteers (29 males and 45 females) participated in the study, aged between 18 and 77 years (34.57 ± 18.22). All participants completed an anonymous questionnaire on the motivations and expectations for participation as volunteers in sporting events based on the model for assessing the expectations of volunteers (Downward & Ralston, 2005), before and after volunteering at the European Adapted Swimming Championship (2016) that lasted 8 days. The T test for paired samples was used to study the differences before and after volunteering in terms of motivation and expectation. Pearson's correlations allowed analyzing the association between the degree of satisfaction and the intention to repeat the experience with the 7 dimensions under study. Multiple linear regression was used to determine the effect of varying the dimensions of motivation and expectations on the degree of satisfaction and to repeat the experience. The statistical software used was SPSS, version 26.0. Results and discussion: The dimensions of personal experience and participation in the community were the most valued, while the dimension of the tradition of volunteering was the least considered before and after the event. Between the two moments, there are differences with statistical significance (p

Introdução: As patologias de foro mental na infância têm vindo a aumentar de forma significativa, afetando a qualidade de vida das crianças/adolescentes. Assim, é imperativo que os agentes educativos tenham formação nesta área de modo a responderem eficazmente às necessidades das crianças/adolescentes. Objetivos: Avaliar a consistência interna e a estrutura fatorial do “Questionário Necessidades Formativas em Saúde e Qualidade de Vida das Crianças e Adolescentes”. Métodos: O estudo psicométrico foi realizado numa amostra não probabilística de 136 agentes educativos (62,5% professores, 32,4% enfermeiros e 5,1% polícias), em média com 48,34 anos, maioritariamente do género feminino (70,6%). Aplicou-se o Questionário Necessidades Formativas em Saúde e Qualidade de Vida das Crianças e Adolescentes. Resultados: As propriedades psicométricas revelaram um instrumento fiável e válido na avaliação das necessidades formativas em saúde e qualidade de vida das crianças e adolescentes por parte dos agentes educativos, apresentando uma adequada consistência interna (alpha de Cronbach total de 0,859) e evidência de validade. Constatou-se que 77,9% consideram ter necessidade de frequentar formação específica nas áreas de saúde mental e QDV das crianças e adolescentes. 22,8% dos agentes educativos não frequentaram formação. Conclusões: A identificação das necessidades de formação dos agentes educativos sobre a saúde mental e a e QDV das crianças e adolescentes potencia a implementação de programas de formação específica ajustados a essas necessidades. Este questionário poderá constituir-se como um importante instrumento para o estudo das necessidades de formação

Syphilis is an old disease and a major public health concern, which is re-emerging in the western world. Atypical syphi- litic presentations can be challenging to diagnose. We present a 23-year-old, HIV-positive man who has sex with men who presented with a 2-week history of an asymptomatic lesion on the glans. Previous topical and systemic treatments proved unsuccessful. Physical examination demonstrated a slightly indurated, ill-defined erythematous plaque over most of the glans. Enlarged, non-tender, bilateral inguinal lymph nodes were palpable. Serological tests revealed a fourfold increase in the VDRL titre (1:8, previously 1:2). A diagnosis of syphilitic balanitis of Follmann was made and complete resolution was achieved with an intramuscular single dose of benzathine penicillin 2.4 MU. Syphilitic balanitis of Follmann represents an uncommon manifestation of primary syphilis, with less than 100 cases reported. Untrea- ted, it will resolve spontaneously, but the patient will remain highly infectious and at-risk for long-term morbidity. In an era in which the number of syphilis cases is increasing sharply both in Western Europe and the United States, all physicians should be aware for the typical and atypical early syphilitic manifestations as they represent opportunities of paramount importance for treatment and epide- mic control.